Hi, all:  Coming out of lurkdom to get on one of my favorite soap boxes in
response to Rene's recent question about Protonix.  Before I step on my soap
box, let me first share the information I sent to Rene privately:

> I don't know why she needs this medication, but it is in a class known as
the proton pump inhibitors, strong inhibitors of acid production in the
stomach.  They are usually used for ulcers or severe reflux.  One better
choice in this class in terms of lactation is omeprazole (Prilosec), which
Hale considers and L2 (safer) because it is  highly degradable by stomach
acid and therefore any which got into the infant's stomach would likely be
destroyed.

There are also excellent drugs which work against stomach acid, among the
older H2 blockers, which are not as potent in blocking acid but are very
effective for most stomach conditions including ulcers and gastritis.  Among
these, famotidine (Pepcid) is an L2 and considered the preferred choice for
breastfeeding mothers, although ranitidine (Zantac) is also and L2 because
very small quantities get into the baby, much less than the dose used in
babies directly for reflux.  Also, nizatidine (Axid) is an L2 because less
than 0.1% of the maternal dose gets into the milk.>

Now for the soap box:  It is beyond my comprehension how physicians reach for
the "latest and greatest" medication when there are numerous tried and true
medications which are equally effective for any particular condition.  What's
worse is a physician who insists that this is the only drug available for the
condition and insists the mother wean.  I also wonder why a pharmacist
wouldn't consider the possibility of discussing an alternative medication
with the physician (pharmacists routinely call me up to ask if I would be
willing to substitute x med for y, and they have no problem calling me if
they have a concern about a medication I have prescribed).

Instead of the onus being on us the lactation supporters to search out the
information on the suitability of a drug for a breastfeeding mom, we should
IMHO be empowering mothers to ask their physicians about possible equally
effective alternatives.  One suggestion I have made to mothers whose
physicians insisted that they must use just one particular medication, was to
ask that physician "doctor, what would you give me if I were allergic to this
drug?"

Best wishes to all for the holidays, Alicia Dermer, MD, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html